Qualitative assay of C-reactive proteins in acute coronary syndromes

Introduction: Acute coronary syndromes (ACS) are the major causes of mortality in coronary care units. Inflammation plays an important role in ACS.  C-reactive protein (CRP) is one of the inflammatory markers, which plays a key role in the pathogenesis. This study aimed at assessing C-reactive protein levels in acute coronary syndromes, and determining its significance in prognosis. Methods: Fifty patients admitted with the diagnosis of ACS were included in the study. Qualitative C - reactive protein assay was done at the time of admission. Patients were followed up for the complications till discharge. Results: Age group between 41 to 70 years constituted 40 (80%) patients. Out of 50 patients with acute coronary syndromes 36 patients had elevated CRP. Thirty patients (83.33%) of them met with complications. Of the 14 patients with low CRP only two (14.28%) patients met with the complications. Conclusions: Qualitative plasma CRP estimation gives valuable prognostic information in acute coronary syndromes

Assessment of Knowledge, Attitude and Practices of Medical Officers in Primary Health Centres Regarding Type 2 Diabetes Mellitus

Background: Health education is an integral part of Type 2 diabetes mellitus (T2DM) management, as it can be prevented and controlled by the implication of appropriate interventions. The aim of the study was to assess the knowledge, attitude, and practice (KAP) of medical officers (MOs) in primary health centres (PHC) regarding T2DM.&#x0D; Materials and methods: The 104 medical officers (MOs) with an experience of £2 years of medical practice were included in the study. A self-completion questionnaire, designed to be completed within 10-15 minutes, was developed to analyse the KAP of the MOs regarding T2DM.&#x0D; Results: Among the 104 MOs, 14 had knowledge about the prevalence of T2DM in India. Among the risk factors, obesity (71), physical inactivity (31), family history (43), and hypertension (15) were identified by the MOs. The microvascular complications, including retinopathy (77), nephropathy (63), and neuropathy (49) were stated by the physicians. However, the physicians were less aware about the macrovascular complications. As few as 23 physicians included HbA1c test as one of the diagnostic methods, 43 physicians included HbA1c to monitor the glycemic levels. More than half (55) of the physicians prescribed appropriate medications for the treatment of T2DM.&#x0D; Conclusions: The MOs had considerable knowledge and attitude about T2DM, however due to lack of facilities at the PHCs, the practice of MOs in the management of T2DM is poor. Education programmes to expand the understanding of the MOs regarding T2DM and initiatives to advance the facilities at PHCs are essential to manage T2DM in India. Keywords: Type 2 Diabetes Mellitus&#x0D; J MEDICINE JUL 2019; 20 (2) : 63-67</jats:p

Knowledge, attitudes, and practices of public sector primary health care physicians of rural north karnataka towards obesity management

Introduction: Obesity is a risk factor for cardiovascular disease (CVD), diabetes mellitus (DM), and hypertension (HTN). In an era of rapidly growing prevalence of obesity, it is important to explore the current knowledge, attitude, and practices of primary care physicians. Materials and Methods: Study participants were medical officers (MOs) of primary health centers in three districts of North Karnataka. The questionnaire was developed by a review of literature in the field and validated with five participants for scope, length, and clarity. Results/Discussion: Of the 102 participants, only 15% were aware about the burden of obesity in India. HTN, DM, and CVD were indicated as comorbidities by 73, 78, and 60 participants, respectively. Only 25 and 12 participants indicated appropriate body mass index (BMI) cut-off values for overweight and obesity diagnosis. Of the 102 participants, 54 were not aware of the guidelines for obesity management. Practices and attitudes of the participants were encouraging. Nearly all of them felt that the adults with BMI within the healthy range should be encouraged to maintain their weight and, three-fourth of them agreed that most overweight persons should be treated for weight loss and small weight loss can achieve major medical benefit. However, nearly half of the participants′ responses were stereotypical as they felt only obese and overweight with comorbidities should be treated for weight loss. Two-thirds of them use BMI to diagnose overweight/obese and nearly all of them advice their patients to increase physical activity and restrict fat. Most of the participants were advising their patients to restrict sugar intake, increase fruits and vegetable consumption, reduce red meat, and avoid alcohol consumption. Conclusion: Present study exposed the lack of knowledge regarding obesity. However, practices and attitudes of the participants were promising. There is a need of in-service training to MOs to further improve their knowledge and practices towards management of obesity

Performance of diabetes risk scores with or without point of care blood glucose estimation

Context: Early detection and optimal treatment of type 2 diabetes mellitus (T2DM) are shown to prevent or delay the complications of the disease. In resource poor settings we need sensitive, specific and inexpensive screening tool to detect people with T2DM. Tools involving point of care blood glucose testing have shown the superiority over others where only history and anthropometry were used. Aims: This study aims to compare the specificity and sensitivity of Indian diabetes risk score (IDRS) and Tabaei and Herman equation based risk score model in a rural community of Northern Karnataka. Materials and Methods: Diabetes prevalence study conducted in rural North Karnataka is used for the present study. All the variables required for calculating IDRS and Tabaei and Herman equation are available from the prevalence study. Instead of random capillary blood glucose, 2 h post 75 g plasma glucose value is used in the equation. And self-reported postprandial time is taken as 2 h. Statistical Analysis: The MedCalc-version 11.3.0 is used for the statistical calculations. DeLong method used to compare the area under receiver operating characteristics (ROCs) of the two risk scores. Results: Three hundred and eighteen participants completed the study and were considered for analysis. In this study optimal, cut-off value for IDRS found to be 40 and for Tabaei et al. equation 0.09. Area under ROC for IDRS was 0.755 (95% CI: 0.680-0.819), and for Tabaei et al. equation it was 0.979 (95% CI: 0.943-0.995). Conclusion: Sensitivity and specificity of T2DM screening tool can be improved by including a point of care blood glucose testing

Clinical characteristics and risk factors for COVID-19-related adverse outcomes in patients with type 2 diabetes mellitus

Background: The association between risk factors and severe acute respiratory syndrome coronavirus-2 disease (COVID-19) related mortality among people with diabetes mellitus (DM) is uncertain. Methods: Consecutive patients with COVID-19 with type 2 DM admitted to our tertiary care centre from July 2020 to January 2021 were included in this cross-sectional study. Data including clinical, laboratory, respiratory, inflammatory biomarkers and radiological parameters were collected and compared between non-survivors and survivors. Cox-proportional hazards regression analyses were performed to analyse the risk factors associated with the mortality in COVID-19 patients with diabetes. Results: Two hundred and sixty three patients with COVID-19 were included. Of these, 173 (65.8%) had survived. Demographic, laboratory, inflammatory and pulmonary parameters were significantly different between the survivors and non-survivors (P < 0.05 for all). Time to hospitalisation from symptom onset (days) was longer in non-survivors compared to survivors (7 Vs 4 days; P = 0.0001). Computed tomography severity scores were higher in non-survivors than survivors (P = 0.0001). The hospital stay was prolonged in non-survivors (P < 0.0001). Adjusted cox-proportional hazard model showed increased neutrophil count and intensive care unit (ICU) admission were independent factors associated with COVID-19-related mortality in diabetic patients. Conclusions: We found that the non survivors as compared to the survivors showed multiple negative outcomes in terms of laboratory, inflammatory and pulmonary findings. ICU admission and elevated neutrophil count were independently associated with death in COVID-19 patients with DM